MR水成像联合颅底三维重建CT对颅底骨折性脑脊液漏的诊断价值  

Diagnostic value of MR hydrography combined with three-dimensional reconstruction CT in cerebrospinal fluid leakage of skull base fracture

作　　者：文世宏 龙青山 李雪松 崔冰 黄国荣 谭杨劲 温一奇 刘惜弟 WEN Shi-hong;LONG Qing-shan;LI Xue-song;CUI Bing;HUANG Guo-rong;TANYang-jin;WEN Yi-qi;LIU Xi-di(Department of Neurosurgery,Huizhou Hospital Affiliated to Guangzhou Medical University(Third People's Hospital of Huizhou City),Huizhou 516000,Guangdong,CHINA)

机构地区：[1]广州医科大学附属惠州医院惠州市第三人民医院神经外科,广东惠州516000

出　　处：《海南医学》2020年第8期1017-1020,共4页Hainan Medical Journal

基　　金：广东省惠州市科技项目(编号:2017Y140)。

摘　　要：目的探究核磁共振(MR)水成像联合颅底三维重建CT(3D-CT)对颅底骨折性脑脊液漏的诊断价值。方法回顾性选取2015年10月至2017年12月惠州市第三人民医院收治的48例外伤性颅底骨折并脑脊液漏患者作为研究对象,所有患者均行头颅MR水成像和颅底3D-CT检查,其中A组16例采用头颅MR水成像+颅底3D-CT检查,B组16例采用MR水成像诊断,C组16例采用颅底3D-CT检查,比较三种检查方法的脑脊液漏口阳性率。患者先保守治疗,无效者行经鼻蝶脑脊液漏修补术。结果A组患者的脑脊液漏口阳性率为93.75%,明显高于B组的56.25%和C组的50.00%,差异均具有统计学意义(P<0.05);A组7例、B组4例和C组3例,保守治疗无效后行手术治疗,术前确定的漏口位置与手术过程中寻找到的漏口位置相符,且手术均成功;随访2个月,三组均未存在复发情况。结论联合使用MR水成像和颅底三维CT重建技术可以提高确定脑脊液漏口位置的诊断率,可以作为外伤性颅底骨折并脑脊液漏治疗的一种评估方式。Objective To explore the diagnostic value of head magnetic resonance(MR)hydrography combined with three dimensional computed tomography(3D-CT)of skull base for cerebrospinal fluid(CSF)leakage in skull base fracture.Methods A retrospective study was conducted on 48 patients with traumatic skull base fracture and CSF leakage admitted to the Third People’s Hospital of Huizhou City from October 2015 to December 2017.All the patients underwent line head MRH and the 3D-CT of skull base.The patients were divided into three groups:group A(16 cases)were diagnosed by head MRH and 3D-CT of skull base,group B(16 cases)were diagnosed by head MRH,and group C(16 cases)were diagnosed by 3D-CT of skull base.The positive rate of CSF leakage in three groups was determined.The patients were treated conservatively first,and those who failed were repaired by transnasal transsphenoidal CSF leakage.Results The positive rate of CSF leakage in group A was 93.75%,significantly higher than 56.25% in group B and 50.00% in group C(P<0.05).Seven cases in group A,4 cases in group B,and 3 cases in group C had operation after the conservative treatment failed.The location of CSF leakage determined before the operation was consistent with that found during the operation,and these operations were successfully treated.Follow-up for 2 months showed no recurrence.Conclusion The combination of head MRH and 3D-CT of skull base can improve the diagnostic rate of determining the location of CSF leakage,and can be used as an evaluation method for the treatment of traumatic skull base fracture with CSF leakage.

关 键 词：核磁共振水成像 颅底三维重建CT 颅底骨折 诊断 

分 类 号：R651.1[医药卫生—外科学]